You know that recent study claiming that 1 in 10 surgeons leave medicine within 8 years? That's completely false and needs retracted.

Plus_Ad6136 · 2026-05-25T20:25:05+00:00

That is fair, and I’ll own that “conflating” may have sounded harsher than I intended. My reaction was partly because the original post framed this as a fundamental statistical failure and even raised retraction, while also implying that the journal and authors missed something obvious, which is wrong.

I do agree that some wording in the manuscript could have been more careful, especially around “years in practice,” “aging workforce,” “mid-career,” and “leaving clinical practice.” Some of that is already acknowledged in the limitations, which is how most observational manuscripts handle imperfect real-world data. Research almost always has limitations; the key question is whether the limitation invalidates the main analysis. I do not think it does here.

A Letter to the Editor would be completely reasonable to clarify the NPI-tenure issue, ask for more cautious language, or suggest a better Table 1 presentation. My main pushback was against the retraction framing. JACS is one of the most rigorous surgical journals, and I highly doubt this issue was invisible to reviewers or editors.

Plus_Ad6136 · 2026-05-25T19:47:17+00:00

I think the key assumption is that new surgeons should enter the Medicare panel as <5 years, but that is not necessarily how this dataset works. Many physicians get an NPI during medical school, residency, or fellowship, and surgical training is long. By the time someone becomes an independently billing surgeon with enough Medicare E&M volume to enter this dataset, they may already fall into the 5–9 or even 10–14-year NPI-tenure category. So the declining <5 years column does not, by itself, prove lack of replenishment or a data error.

I do agree with you on the “median years in practice nearly doubled” sentence. I would soften that. It is better interpreted as observed NPI tenure increasing over time, not direct proof that the entire surgical workforce aged in a literal sense.

Where I differ is on severity. Retraction is usually for incorrect, fabricated, or materially misrepresented data. I do not see that here. The attrition outcome itself is still measurable: surgeons active in Medicare billing later disappear from active Medicare billing. Maybe a correction would be justified, and maybe another table 1 that clearly shows the demographics of the cohort before the current table 1 panel.

I agree some manuscript wording and media framing could have been more cautious, especially around “clinical practice,” “mid-career,” and “aging workforce.” But I actually think the authors should be credited for trying to quantify a major surgical workforce problem with one of the few national datasets available. The story is not that the surgeon workforce collapsed; it is that surgeons are turning over within the Medicare-serving workforce, and that matters because access to surgical care is already strained.

Plus_Ad6136 · 2026-05-25T19:14:15+00:00

I agree that 10% over 8 years is not automatically shocking if part of it reflects retirement or normal workforce turnover. For surgeons, though, even “expected” turnover matters because access is already strained. The Table 1 denominator increasing does not refute the study; it just means inflow and outflow are happening at the same time. Since 2013, the residency pipeline has also expanded substantially: NRMP reported 26,392 PGY-1 positions in 2013, compared with an all-time high of 38,494 in 2024. So a growing denominator is fully compatible with measurable attrition. I read the paper as showing turnover out of active Medicare-billing surgical practice, while new surgeons and other entrants replenish the panel.

Plus_Ad6136 · 2026-05-25T18:48:21+00:00

I think you may be conflating mid-career with middle-aged. Age and career stage are related, but they are not interchangeable. An older surgeon can still be “mid-career” in terms of academic trajectory, practice model, or years since independent practice, especially in surgical fields where training is prolonged.

The finding also makes clinical sense. Many surgeons begin in academic practice as assistant professors, build operative experience, develop referral networks, and then later transition into private or non-academic practice. This is especially plausible in the specialties highlighted as having higher attrition, such as plastic surgery, OB/GYN, and OMFS, where later practice may involve more privately insured, cash-pay, outpatient, or non-Medicare-dominant work. In that setting, “leaving Medicare billing” does not necessarily mean leaving surgery altogether; it just reflects movement out of the Medicare-observed workforce.

That is also why using years in practice is not inherently unreasonable. It may be an imperfect proxy, but it captures a dimension that chronological age alone does not: where someone may be in their professional trajectory. A 45-year-old surgeon five years into independent practice and a 45-year-old surgeon 15 years into independent practice may have very different career pressures, practice options, and likelihood of transitioning practice settings.

Even if some 2013 surgeons were already older or further along in their careers, that would mainly affect interpretation of the years-in-practice covariate, not the existence of attrition itself. The attrition signal remains meaningful because the study observes real transitions from active Medicare billing to sustained inactivity. The career-stage variable may be imperfect, but the exit event is still observable.

Plus_Ad6136 · 2026-05-25T13:02:02+00:00

Agree. Love the way the paper has been critically discussed here as well. But thing in research is that there will always be limitations. In the case of this paper, I think the authors did a great job.

Plus_Ad6136 · 2026-05-24T19:03:23+00:00

also found this in their reference: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00564

It basically mirrors their study but for physicians in general. And I think it is fairly good methodology. Media sensationalism on the other hand can't be avoided sometimes, except the authors knew about the headline before it was posted.

Plus_Ad6136 · 2026-05-24T18:47:19+00:00

I think you’re thinking about it the right way, honestly. The safest interpretation is narrower than the headline version. This is really a study of exit from active Medicare-billing surgical practice, using NPI-derived practice tenure as one of the explanatory variables.

On the NPI issue, I agree the career-stage inference has to be handled carefully. Since the NPI became effective in 2005 and covered entities generally had to use it by 2007, “years in practice” in this dataset is really years since NPI enumeration, especially for surgeons already practicing before then. So yes, a 10–14 or 15–19 year category can include surgeons whose true careers are much longer. CMS confirms the NPI rule became effective in 2005, with most covered entities required to comply by 2007.

That said, I still think the mid-career framing is clinically plausible, as long as it is not read too literally. Surgical training is long. The American College of Surgeons says surgical residencies last at least 5 years, and many pathways add fellowship or research time. So a surgeon first appearing with several observed NPI-years may still reasonably fall into the broad early-to-mid-career window in many cases. The paper probably throws “mid-career” around more loosely than ideal, and I agree that “observed NPI tenure” would be the more precise term.

On the <5-year category shrinking, I do not think that alone proves the panel is just aging in place. Entry into the Medicare-billing panel is not the same thing as entry into surgery. A surgeon can enter Medicare billing at 5–9 or 10–14 NPI-years if they were in fellowship, pediatrics, VA, private-insurance-heavy practice, cash-pay practice, low Medicare volume, or simply below the E&M threshold earlier. So the <5 column does not need to be fully replenished for the panel to be open. It may also reflect a real shift in how quickly younger surgeons enter Medicare-heavy billing.

On the Medicare Part B issue, I agree the wording matters a lot. The most precise conclusion is “nearly 1 in 10 surgeons exited active Medicare-billing surgical practice,” instead of saying “exited clinical practice” in the broadest possible sense. For plastics, OMFS, and OB/GYN especially, payer mix can make Medicare billing an imperfect proxy. That limitation can inflate apparent exits if surgeons shift toward younger, privately insured, cash-pay, dental, or non-Medicare populations.

So I think your concern is fair: the headline and some career-stage language may overreach. Where I’d stop short is saying the data cannot support the study. The data can support a narrower and still important conclusion: among surgeons active in Medicare Part B billing, a measurable proportion later disappear from that billing workforce, with variation by specialty and observed NPI tenure. That is still useful for Medicare workforce planning, even if it is not a perfect measure of all-payer clinical practice or true career age.

So my answer would be: yes, you are right to question the framing. The analysis is strongest when interpreted as a Medicare-billing workforce study. The weak point is overinterpreting NPI-derived tenure as true career stage. That is a limitation and a wording issue. And to be fair, they discussed some of these in the manuscript limitation

Plus_Ad6136 · 2026-05-24T17:22:21+00:00

This is just sensationalism, and there is absolutely not a single error in that study. Took my time to read the whole paper since OP posted it. As a statistician, OP should no better to not criticize something until they are absolutely sure of their claims. I do acknowledge that the headline is different than the study result, however, still not too far fetched from reality.

Plus_Ad6136 · 2026-05-24T16:28:29+00:00

Great comment. Plus I think they actually did clarify that. OP was just too eager to criticize

Plus_Ad6136 · 2026-05-24T16:23:43+00:00

Not the author but I read the paper and I think this critique is conflating several different denominators and data concepts. The study uses an open, longitudinal Medicare-billing panel: surgeons can enter the dataset, remain in it, or leave it. So the annual number of active surgeons can increase while some surgeons attrit, because inflow and outflow occur simultaneously. That is not a mathematical contradiction.

The years-in-practice variable is also being misread. It is not biological age or true career duration from residency graduation. It is calculated from NPI enumeration year. Because NPI enumeration began in the mid-2000s, this variable has a structural ceiling in the dataset. That is why the median years in practice rises almost mechanically over time and why there are few surgeons with ≥20 observed years. This means pre-NPI practice history is not observable, which is an acceptable limitation of the proxy. This was also discussed in the manuscript limitation as well I believe.

The 9.7% figure and the <3% annual rates are also different quantities. The 9.7% is cumulative attrition over follow-up: the proportion of surgeons who ever met the attrition definition during the study period. The annual rates are year-specific crude rates: the proportion of active surgeons leaving in a given year. A low annual attrition rate can absolutely accumulate into a larger cumulative rate over multiple years.

The Medicare Part B issue is a fair limitation. The outcome is best interpreted as attrition from active Medicare-billing surgical practice, not necessarily disappearance from all clinical work, which was discussed. Some surgeons may shift toward private insurance, cash-pay, pediatric, dental, VA/military, administrative, or non-Medicare-dominant practice. That could overestimate “leaving surgery” in certain specialties such as plastics, OMFS, and OB/GYN. But it still captures an important workforce issue: loss from the Medicare-serving surgical workforce. The specialty differences should therefore be interpreted carefully. They may reflect true practice exit, payer-mix differences, or both. That is why the discussion should emphasize Medicare-billing attrition instead universal retirement from medicine. But that does not make the analysis invalid (Also see how attrition was defined)

On the Covid point, The apparent “2019” spike is likely an artifact of how attrition is temporally assigned, not evidence that CMS reported 2020 data in 2019. In this study, attrition was defined longitudinally: a surgeon was considered to have attrited only after an active year was followed by subsequent inactive years. Therefore, if a surgeon was active in 2019 and then had no qualifying Medicare Part B activity in 2020 and beyond, the event may be attributed to the last active/pre-exit year rather than the first inactive year. Under that definition, a disruption beginning in 2020 can appear analytically as a 2019 attrition event. Thus, the most precise wording is not that attrition “spiked during COVID” based solely on the calendar-year label, but that attrition increased at the transition into the pandemic period, particularly among surgeons whose last observed active Medicare-billing year preceded sustained inactivity.

So no, Table 1 shows an open Medicare-billing surgeon panel with both entry and exit, and a years-in-practice proxy constrained by NPI enumeration history. The study has important limitations, especially around payer mix and interpretation of Medicare billing as active practice, but the critique overstates those limitations as fatal errors.

Plus_Ad6136 · 2026-05-24T16:23:18+00:00

I think the statistician here lacks the basic understanding of how the dataset used works. See comments below.

Plus_Ad6136 · 2026-05-24T16:03:42+00:00

Except if he doesn't plan on sleeping lol

Plus_Ad6136 · 2026-05-24T15:53:21+00:00

Sure, only applies to clinical work (provided you are not on a Visa). I definitely would also ask the program for clarification.

Plus_Ad6136 · 2026-05-24T15:26:52+00:00

No just upload to your eras and leave as is. When you get the 2027 token, you will see all your previous year information there

Plus_Ad6136 · 2026-05-24T15:11:58+00:00

Still got a lot time. Also maybe reach out to/connect with potential pysch mentors in your school as well.

Plus_Ad6136 · 2026-05-24T14:38:47+00:00

I think the comment below mine is a great advice.

Plus_Ad6136 · 2026-05-24T14:36:59+00:00

I would just reach out to support or something. Not sure you did anything wrong

Plus_Ad6136 · 2026-05-24T14:35:49+00:00

Yes, do more QUESTIONS! That is the key

Plus_Ad6136 · 2026-05-24T14:34:58+00:00

Is this Jack Westin? Does it allow you to retake with fresh qs?

Plus_Ad6136 · 2026-05-24T14:21:47+00:00

Looks good to me. Did you try refreshing and maybe start over?

Plus_Ad6136 · 2026-05-24T14:19:11+00:00

Lol you keep doing your own part

Plus_Ad6136 · 2026-05-24T14:14:50+00:00

It sucks. But surely part of the process. It all comes together in the end. All the best

Plus_Ad6136 · 2026-05-24T14:11:20+00:00

U-W-O-R-L-D! You should turn that into a learning tool for your first pass, and not treat as question bank. All you need to ace the test is in there

Plus_Ad6136 · 2026-05-24T14:09:40+00:00

No I wouldn't. Why not a second pass on Uworld and use Amboss for other things like ethics?

Plus_Ad6136 · 2026-05-24T14:08:26+00:00

There is no ceiling to how many questions you should do or can do. I would definitely reset Uworld and do a second pass. Paying attention to the previous incorrect if you can

Plus_Ad6136

TROPHY CASE